CHAMPS: Choices for Adolescent Methods of Prevention in South Africa

描述（由申请人提供）：在南非，年轻人是普通人群中艾滋病毒感染率最高的人群。青春期是一个复杂的、过渡性的发展阶段，与艾滋病毒感染相关的行为往往在这个阶段开始，因此，任何当前或未来的艾滋病毒预防战略都可能需要得到年轻人的有效利用，才能在人口层面产生明显的影响。但是，尽管在年轻人中开展艾滋病毒预防工作很重要，但在南非和其他资源有限的环境中，很少有干预措施对减少这一群体感染艾滋病毒的风险产生重大影响。该项目将通过一种新的办法来解决这一差距，将不同的艾滋病毒预防战略结合成一个针对青少年的最佳预防“菜单”，有感染艾滋病毒风险的青年男女可以从中选择一种特定的战略组合，以满足其具体需要和情况。目前，有一些有希望和经过验证的预防干预措施，可能构成一个预防菜单的首选方案或组合，包括PrEP，杀微生物剂，艾滋病毒咨询和检测（HCT）和包皮环切术。在对与这些和其他预防方案有关的文献进行系统审查后，将设计试点研究，以审查与这些预防方法在青少年中相关的可行性、可接受性、依从性和性行为改变等关键问题。研究将尽可能模拟服务和试验的执行情况，以解决这些问题，包括与执行和提供有关的伦理法律问题，以及考虑向青少年宣传和社会推销这些方法。研究结果将用于为流行病学建模和成本计算工作提供信息，以便为如何在青年人中构建和推广这一预防“菜单”提供信息，以实现最大效益。这项研究将在一项单独的试验中达到高潮，该试验旨在检查“菜单”方法在预防南非青少年新的艾滋病毒感染方面的有效性。

DESCRIPTION (provided by applicant): In South Africa, young people have the highest incidence of HIV infection in the general population. Adolescence is a complex, transitional development phase when behaviors associated with HIV acquisition are often initiated, and it is likely that any current or future HIV prevention strategy will need to be effectively utilized by young people to have an appreciable population-level impact. But despite the importance of HIV prevention efforts among young people, there are few interventions that have demonstrated a significant impact in reducing risk of HIV infection among this group in South Africa and other resource-limited settings. This project will address this gap through a novel approach to combining different HIV prevention strategies into an optimized prevention 'menu' for adolescents, from which young women and men at risk of HIV infection may choose a particular combination of strategies to meet their specific needs and circumstances. Currently there are a number of promising and proven prevention interventions that could potentially constitute a prevention menu of preferred options or combinations, including PrEP, microbicides, HIV Counseling and Testing (HCT) and circumcision. After a systematic review of the literature relating to these and other prevention options, pilot studies will be designed in order to examine key issues of feasibility, acceptability, adherence and sexual behavior change associated with these prevention methods in adolescents. Studies will emulate implementation of services and trials as far as possible in order to address these questions, including ethico-legal issues associated with implementation and delivery, as well as consideration of messaging and social marketing of these approaches to adolescents. Results will be used to inform epidemiological modeling and costing exercises in order to inform how such a prevention 'menu' should be constructed and promoted among young people for maximum benefit. This research will culminate in a separately proposed trial to examine the efficacy of the 'menu' approach in preventing new HIV infections among South African adolescents.